Alan Johnson: General practitioners in England are,among the best in the world. A recent international survey by the Commonwealth Fund showed that the United Kingdom stands out as a clear leader in providing the right incentives for high quality care. I know from my conversations with GPs that many are aware of the need to continually improve services in response to rising public expectations.
	In some places, however, patients find it difficult to get an appointment with their GP at a convenient time. For some patients, having a GP surgery that is only open when they are at work is a great inconvenience. In other cases, the ease and convenience of booking or gaining repeat prescriptions could be improved. In some 'areas, particularly the more deprived, there are fewer GPs and GP services than patients could rightfully expect.
	These are major challenges for the 21st Century National Health Service as it seeks to improve in response to the rising expectations of patients; expectations for both convenience and quality.
	The patient survey of GP services, undertaken between January and March 2007, is the largest ever survey of patients regarding the primary care services they receive. Over 2 million responses were received, giving us a major insight into patients' views of access to GP services. The survey will be used to inform the Government's longer term primary care strategy.
	The survey shows that many patients report a good experience of GP services. This is a testament to the hard work and dedication of GPs, primary care nurses and other practice staff. The survey shows:
	86 per cent. of people were satisfied that they could get through to their doctor's surgery on the phone;
	86 per cent. of people who tried to get a quick appointment with a GP were able to do so within 48 hours;
	75 per cent. of people who wanted to book ahead for an appointment with a doctor reported that they were able to do so;
	88 per cent. of people who wanted an appointment with a particular doctor at their GP surgery could do this;
	84 per cent. of people were satisfied with the current opening hours in their practice; and
	94 per cent. of people who were referred by a GP discussed choice of hospital.
	The summary report has been placed in the Library and the full results of the survey can be found at: http://www.dh.gov.uk/gppatientsurvey2007.
	Practices that offer an accessible service that patients are satisfied with will now receive a payment triggered by the survey results; practices with dissatisfied patients will not. Around £100 million in GP income is linked to the survey results, providing a clear incentive for increased responsiveness,
	Of those patients not satisfied with the current opening hours in their practice, 46 per cent. said they wanted the practice to open on a Saturday and 26 per cent. said they wanted the practice to open on a weekday evening.
	In addition, people from minority ethnic communities, particularly Bangladeshi and black African groups, were more likely to be dissatisfied with a range of GP services than their white counterparts. There are marked differences in satisfaction between different ethnic groups:
	Black/Black British people and Asian/Asian British people had satisfaction rates around 5-10 per cent. below white British people.
	People from a Bangladeshi backgroun4 have lowest levels of satisfaction (around 20 per cent. below white British people).
	In addition to the concerns raised in the survey, we also know that there is a persistent problem of insufficient doctors in the most deprived areas. For example, last year Barking and Dagenham had 43 GPs per 100,000 population while Northumberland Care Trust had 88; the England average is 61.
	The world-class services celebrated in international surveys should be available to all patients in all communities. Good primary care services mean different things to different people and therefore services must be sensitive and responsive to patients' needs.
	Lord Darzi's NHS Next Stages Review will look at these issues in detail and make its first, interim report in October 2007, setting out the route by which the NHS of the 21st Century will offer a service which meets the needs of modern patients living busy lives. However, in some areas highlighted by the survey, we can make faster progress and I am announcing five measures today to begin this process:
	1. I will ensure Primary Care Trusts (PCTs) analyse this rich data and produce robust local action plans to address concerns expressed by patients. These will be made available to the NHS Next Stages review in which I am asking PCTs to actively engage. They will show how PCTs can use existing powers to make rapid service improvements in GP services by the end of this year.
	2. Patients tell us they want better information about their own and other GP practices. We will publish new practice data on the NHS choices website, covering practice opening hours and available appointment times, indicators of the quality of care, and what extended services the practice offers. This will be an important first step in improving the information available to patients.
	3. I am establishing a National Improvement Team led by the National Clinical Director for Primary Care, David Colin-Thome, who was a highly respected practising GP for over 35 years. This team of experts will give targeted support to poorly performing PCTs and practices to improve access. Their initial focus will be on the areas with the lowest patient satisfaction and fewest doctors per head.
	4. I have also asked Professor Mayur Lakhani, the Chair of the Royal College of GPs and a highly respected practising GP, to look at the complex issue of why primary care services are not currently meeting the needs of people from black and minority ethnic communities. He will work closely with the Darzi review in advance of recommendations to tackle these inequalities later this year.
	5. The publication of the survey results releases some incentive payments to GPs who are rated very highly for access. To ensure services continue to improve, I have asked Lord Darzi, through the NHS Next Stage Review, to work with the BMA to review the current incentives for GP services (the QOF). Lord Darzi will consider the potential for GPs to be asked to achieve even better outcomes for their patients in order to earn the same level of incentive. In particular Lord Darzi will look at how QOF can reward responsiveness to patient experience in a more effective way, addressing local issues and concerns.
	I expect practices with low satisfaction rates to make substantial improvements as a result of these measures. My Department has already agreed a new performance indicator with the Healthcare Commission that uses data from the patient survey. This will ensure that low-scoring PCTs who do not make the improvements that their patients want to see will have their ratings marked down.

Ann Keen: A summary of the responses received during a public consultation exercise, based on the Chief Medical Officer, Sir Liam Donaldson's report, "Bearing Good Witness: Proposals for reforming the delivery of medical expert evidence in family law cases", has been placed in the Library and is available on the Department of Health website at: http://www.dh.gov.uk/Consultations/Live Consultations/fs/en.
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	The report's key proposal is that protecting vulnerable children should be a public service, and that the National Health Service should develop a new resource for the family courts by establishing expert witness teams of specialist doctors and other healthcare professionals.
	The consultation attracted responses from a wide spectrum of parties and organisations with interests in the family court system. The results from 135 responses received indicated that over 60 per cent., and almost all key stakeholder organisations, approved the proposal to introduce NHS expert witness teams and to commission the expert witness service through a public sector organisation.
	The responses confirmed that the introduction of NHS teams should not reserve the work to the NHS, but should offer an additional source of expertise. Responses also suggested that the activity of these teams should be confined, at least for the present, to public law family cases where joint instructions apply, and be commissioned regionally to ensure the independence of NHS experts from the local authority and staff directly involved in the case.
	Consultation responses raised concerns over the ability of the NHS to undertake this work within its resources, a shortage of doctors willing to act as expert witnesses, time constraints for those who chose to do so, and possible conflict between a requirement to assist the courts and clinical responsibilities. The availability of trained professionals, particularly those involved in child safeguarding and shortages of consultants in child and adolescent mental health and in paediatric radiology were among concerns raised over NHS skill levels in some specialised areas.
	A substantial number of respondents focused on the deterrent effect of referrals of expert witnesses, particularly paediatricians, to their regulatory body as an unwarranted consequence of their giving expert evidence in court—and regardless of any legitimate cause for complaint. Further measures are envisaged to counter this effect. The Government fully recognises that in order for health professionals to do their job properly and effectively, they need to be clear about the boundaries of the professional and legal framework in which they work. The issues here go broader than those around expert witnesses, into the wider role of medical professionals in the detection and investigation of child abuse and neglect.
	In order to help clarify the situation I have recently written jointly with my hon. Friend, the Member for Cardiff West (Kevin Brennan), the Parliamentary Under-Secretary of State, Department for Children, Schools and Families to relevant organisations with a statement setting out the Government's understanding of the legal position as considered in some recent judgements.
	The statement, which outlines professionals' duty of care, the legal framework within which they operate, and the basis on which sound professional judgments should be made, has been placed in the Library and is available on the Every Child Matters website: http://www.everychildmatters.gov.uk/safeguarding.
	The role of doctors and other healthcare professionals in acting as expert witnesses is both fundamental and vital to the safeguarding of children's welfare. Any diminution in this resource would be extremely detrimental, and especially to the most vulnerable children and those most at risk of abuse. We shall therefore be supporting the NHS in taking forward the introduction of teams. We envisage this will be through the introduction of path-finding teams in the first instance, but gradually increasing so that NHS healthcare expert witness services will eventually be available throughout the country.